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Experiential learning
2020-08-31 
Wang Guangfa (right), an expert from the National Health Commission, treats a COVID-19 patient at the Dalian Sixth People's Hospital affiliated to Dalian Medical University in Liaoning province. [Photo provided to China Daily]

Wang Guangfa's battle with COVID-19 was different from that of other front-line experts.

From the SARS outbreak in 2003 to the Wenchuan Earthquake in 2008, and from the H1N1 swine flu in 2009 to the plague in the Inner Mongolia autonomous region last year, Wang Guangfa, a respiratory expert at Peking University First Hospital, has spent his career on the front lines.

The COVID-19 pandemic was no exception. He was in Wuhan, capital of Hubei province, as part of the National Health Commission's group of experts dispatched to the stricken city in early January. When the pandemic reoccurred in the coastal city of Dalian, Liaoning province, in late July, Wang, 56, once again packed up his gear and headed to the viral hot spot to help.

His fight against the epidemic was slightly different this time-he was, for the first time, infected on the front line.

Confirmed positive for the novel coronavirus on Jan 21, Wang spent nine days in hospital waging a personal battle against the disease as a patient, and the experience also helped him to better understand COVID-19 and how to use that knowledge to more effectively treat his patients.

Solving the puzzle

Wang arrived in Wuhan on Jan 8.The following day, he visited Wuhan Jinyintan Hospital, checking the novel coronavirus patients in the ICU. Wang helped staff at the hospital to intubate a patient.

Even though intubation is a procedure that carries a risk of infection for the doctor, Wang believed that, with his protective clothing, N95 mask, goggles and anti-spatter mask, the chance of him getting infected was slim.

On Jan 14, Wang visited the fever clinic at the Union Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology.

In the small but crowded lobby, Wang stayed for more than an hour talking to the patients.

"I was probably infected there through aerosol transmission, because the room was not well ventilated and there were too many patients in the small space. I wore a N95 mask but no protective eyewear," Wang recalls.

The head of the fever clinic who welcomed Wang also became infected with COVID-19, showing symptoms the very next day, which makes Wang more confident in his belief that he was infected at the Union Hospital while he reviewing the infection process.

Wang returned to Beijing on Jan 16 where he joined a meeting to offer feedback on the Wuhan trip with the National Health Commission on the same day.

By the afternoon, he began feeling discomfort in his left eye, which soon extended to his right. Both became red. Wang developed a fever that night, with symptoms of nasal stuffiness and a runny nose.

Wang thought he had caught the flu. He self-quarantined at home and treated himself with cold and flu medicine but, four days later, the fever had still not abated.

"The 41 cases of COVID-19 patients in Wuhan did not have symptoms on the upper respiratory tract like me, which was why I thought I had flu at first," Wang says. "Also, it was rare that I was infected through conjunctiva."

Wang (second left) communicates with medical staff at the hospital. [Photo provided to China Daily]

On Jan 21, Wang underwent a nucleic acid test and was confirmed to be infected with COVID-19. He was transferred to hospital later that day.

His doctor recommended the use of HIV drugs, which combine lopinavir with a low dose of ritonavir, which reduced Wang's fever within a day.

Wang recovered and was discharged nine days after he was hospitalized.

The World Health Organization subsequently stopped the trial of lopinavir/ritonavir on hospitalized COVID-19 patients in July, because the interim trial results showed that, when compared the standard of care already being provided by hospitals, the drugs produced little or no reduction in the mortality of those infected.

"I was lucky that the drugs worked on me, but it did have side effects, like muscle weakness," Wang says.

A new disease

On Jan 10, Wang told China Central Television that the outbreak was controllable, which caught the public's attention.

He shared the fact that he had become infected through the eyes on Sina Weibo, sending a warning to both the public and medical workers about the importance of eye protection.

After the investigation in Wuhan, Wang presented his conclusions and suggestions to the National Health Commission, some of which have been applied in the ongoing prevention effort.

One of his suggestions at the time was to pay attention to patients in the cities around Wuhan. "Back then, all the focus was on the outbreak in Wuhan, but the city is the capital of Hubei province and it was about time of Spring Festival with greater movement among the population, so I noted that the cities around Wuhan should also be concerned," Wang says.

Wang also suggested speeding up the detection process of the virus so that patients could be diagnosed as soon as possible.

"I saw the doctors and nurses getting exhausted in Wuhan. They were short-handed and under high pressure," Wang recalls. "I suggested beefing up the quota of medical staff in Wuhan, as well as shortening their shifts.

"The usual 8-hour shift was too long for them to be working in protective clothing, and if they were too exhausted, their immunity might decrease and make them more vulnerable to infection," he says.

After Wang was admitted into hospital, he received the files of 600 COVID-19 patients and was asked to study them. After he was discharged, he devoted himself to his work, shuttling between his hospital and National Health Commission meetings.

Wang now leads a team of 20, and has the further assistance of many experts from different fields, that use artificial intelligence to analyze the cases of COVID-19 patients from around the country.

"We have collected data on more than 70,000 cases, including around 15,000 cases that have full reports, which is a lot of work to do," Wang says.

As a former COVID-19 patient, Wang has gained more knowledge and experience about the virus. As a doctor and a public health expert, Wang says in light of the current pandemic, doctors should shoulder some responsibility concerning public health.

"The doctors in Wuhan have done a good job in identifying this new, infectious disease, but we still need to strengthen the awareness and vigilance among doctors," Wang says.

Wang (center) in a meeting at the Dalian Sixth People's Hospital affiliated to Dalian Medical University in Liaoning. [Photo provided to China Daily]

Tech pioneer

Wang graduated from Beijing Medical University in 1987. He chose to become a respiratory physician after being deeply affected by his role in helping to save the life of a seriously ill patient during his internship.

He says among all professions, doctors are able to realize the value of their work when they help a patient who enters the hospital on a gurney, to recover and walk out on their own feet.

To be a respiratory physician, Wang says that one needs to face many challenges, including a variety of common illnesses, complicated pathogenic mechanisms and many difficult miscellaneous diseases.

During his 33 years of experience in the field of pneumology, Wang has been a pioneer of new technology in the treatment of patients.

"As the development of medical disciplines bring more convenience to patients, doctors should continue to learn," Wang says. "It's a huge risk to use new technology for the first time. But for the patients, we should have the spirit to take up the challenge."

Wang says the use of new technology should not simply be to just to explore innovation, but should be based on the needs of the patient.

"When we are preparing an operation, we are not only thinking about how it could benefit the patient, but also what risks the patient might be facing," Wang says.

Ma Jing, a colleague of Wang, says he has a strong will and a sense of curiosity.

She says Wang is always exploring new technologies, techniques and ideas to help his patients, and he has an insight into the future trends of his field.

"The work is high-pressure, as the patients who come to him from across the country have a miscellany of difficult illnesses, and some are even in a life-threatening position when they arrive," Ma says.

Operating in the airways always carries a high risk, Ma notes, adding that a patient might already be suffering from airway stenosis-a narrowing trachea, commonly referred to as the windpipe-and the instrument required to enter the airway to perform the operation occupies vital space. One mistake might cause apnea.

According to Ma, if Wang is needed by a patient when he is off duty, as long as he is in Beijing, he will come to the hospital. "Even when you call him at 2 am, he will come, and he never complains."

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